The link between certain working conditions and structures and the development of metabolic disorders is increasingly of interest to occupational medicine, as diabetes plays a key role in the development of cardiovascular disease. The following pages provide information about the causes and distribution of diabetes, its relevance for occupational medicine, and possible preventive measures.

Due to the high rate of type 2 diabetes in the population, other forms of diabetes and other metabolic disorders are not discussed in detail.

Forms of diabetes

Diabetes mellitus, commonly known simply as diabetes, is a group of metabolic disorders caused by a lack of the hormone insulin or a reduced effectiveness of the insulin produced, resulting in chronically high blood sugar levels (hyperglycaemia). Forms of diabetes are differentiated by their underlying cause:

• Type 1: Autoimmune disease where the body cannot produce insulin
• Type 2: Acquired insulin resistance
• Other forms that do not fall within type 1 or 2: caused by disease, injury or inflammation and a resulting lack of insulin or reduced effectiveness of insulin
• Gestational diabetes: Insulin resistance acquired during pregnancy

Incidence of type 2 diabetes

Type 2 diabetes is the most common form of diabetes in adults, accounting for 93% of diabetes cases. In 2022, around 8.7 million people had diabetes in Germany, with an estimated two million or more living with undiagnosed type 2 diabetes. More than 500,000 people are diagnosed each year and numbers are expected to continue increasing.

The proportion of people with diabetes increases with age. Whereas diabetes affects 1.5% of those aged 30 to 39 and 9.8% of those aged 50 to 59, the diabetes rate in the 60 to 69 age group is 20.9%, rising to 33.1% for those aged 80 and over. This increase in older age affects both women and men, although the incidence among women in all age groups from age 40 onwards is lower than for men (Diabetes-Surveillance 2022). The average age at diagnosis for type 2 diabetes is currently 61 for men and 63 for women, although more and more younger people have been affected by the metabolic disorder in recent years. Combined with increasing life expectancy, an early diabetes diagnosis means a long duration of diabetes and a high risk of complications.

There is also a link between socio-economic factors and diabetes, with higher diabetes levels among those with lower educational qualifications than among those with higher qualifications.